Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity reaction to aspergillus fumigatus that can occur in patients with asthma or cystic fibrosis. In a significant proportion of patients, recurrent inflammation and infection can lead to mucoid impaction and segmental or lobar collapse. The mainstay of treatment for these patients is inhaled and oral corticosteroids, regular chest physiotherapy, mucolytic therapy, and oral anti-fungals. In our own experience, we have found that a minority of patients continue to suffer from recurrent lobar collapse despite maximal medical therapy and regular physiotherapy. This can lead to significant morbidity and recurrent hospital admissions, and presents a difficult management problem. In 5 of our patients who continued to suffer from recurrent mucoid impaction and lobar collapse despite maximal medical therapy, we instituted a program of regular prophylactic bronchoscopy and lavage of the affected lobes. The frequency of lavage ranged between 6 weekly and 3 monthly and was adjusted depending on the individual patients' level of disease activity. We found this approach to be of prognostic benefit. Further episodes of lobar collapse were avoided, improvements in airflow limitation and symptoms were seen in some patients, and there was a reduced frequency of emergency hospital admissions. There were no complications and performing regular bronchoscopies was safe in this population. This treatment can be used as an interim measure pending improved control of the patient's underlying disease, or continued on a long-term basis if required.
Full conference title:
20th European Respiratory Society conference
- ERS 20th (2010)